[Editor's Note: This is an essay from one of the finalists in our scholarship competition. I have no financial relationship with any of the finalists, except the eventual winner, who will get a big check from WCI.]
Bole, Northern Region, Ghana: a new mother is lying on the ground in the hospital corridor, her body curved around her newborn daughter, waiting to see the sole physician in the entire district. Belmopan, Belize: a little girl with a fever of 104 wails at the sight of a stethoscope; to her, basic medical care is foreign and terrifying. McKeesport, PA, USA: a middle-aged man comes into the 9th Street Clinic with headaches, changes in his vision, and a blood pressure of 190/100, worried that he cannot pay for his medications because he recently lost his job and apartment. The next patient is a young female genuinely surprised to learn that her cigarette smoking is exacerbating her asthma and negatively affecting her 10-week-old fetus.
While the first two examples were snapshots of meaningful experiences in my global health career, the most disconcerting realization for me during my medical school rotations was recognizing the preventable healthcare disparities happening in my own backyard – not just 10,000 miles and oceans away, but right here in Pennsylvania. According to the National Health Service Corps, there are 846 Health Professional Shortage Areas (HPSAs) for Primary Medical Care in Pennsylvania. Unfortunately, these numbers are no better on a national level. The U.S. Department of Health and Human Service reports over 5,800 HPSAs across the country, and the future looks equally grim. A 2015 study by the Association of American Medical Colleges (AAMC) estimates a shortage of 31,000 primary care physicians by 2025.
This deficit comes as no surprise. For years major organizations and newspapers like the Washington Post and New York Times have been reporting on the physician shortage. Dr. Pauline Chen, M.D. authors an article called “Where have all the primary care doctors gone?” in which she speculates “much of the problem lies in what general practitioners have to look forward to. General practitioners work as many hours as, or more, than their subspecialty colleagues. Yet they have among the lowest reimbursement rates.
They also shoulder disproportionate responsibility for the bureaucratic aspects of patient care, spending more time and money obtaining treatment authorization from insurance companies, navigating insurers’ ever-changing drug formularies and filling out health and disability forms.” Understanding and uncovering factors that do succeed in attracting medical students to family medicine would take numerous studies. I do not speak for the rest of the medical field and I cannot explain every individual’s reasoning. But I can certainly explain mine.
Coming from a strong background in community service – from the Girl Scouts National Gold Award to leading a small 501 (c) 3 global health non-profit in Ghana – I always thought I would be interested in primary care. To put it simply, I wanted to help people in a field where help was needed. This field appeared to be family medicine. After all, as the president of the American Academy of Family Physicians (AAFP) Dr. Robert Wergin, M.D. recently pointed out, “the percentage of our current physician workforce practicing in [primary care] is at an all time low.” My reasoning stuck with me through medical school, but after spending more time in clinical settings I soon discovered other, additional reasons I was interested in primary care.
One case stood out to me in particular. Because I earned my master’s degree in bioethics, I had the opportunity to participate in family ethics meetings during my medical school clinical rotations. In this case, the patient had Stage IV lung cancer and wished to withdraw treatment and begin at-home-hospice care. His family was distraught, confused, and adamantly disagreed. Amidst the emotional debate, the patient requested the presence of his family medicine doctor of over 30 years. Curious, a family member asked the patient why he wanted the counsel of this physician specifically. A social worker, oncology specialist and palliative care expert were already there gathered around the table. The patient answered without needing a moment of thought. Through countless specialist consults and procedures, the family medicine doctor had been the patient’s sole source of consistent care. Through births in the patient’s family, the family medicine doctor had been a coach, educator, and then healthcare provider to the new children as well. Through deaths in the patient’s family, the family medicine doctor had been a caring counselor. To quote the patient, his family medicine doctor had “been there through it all.” When the physician did arrive, his deep understanding of the patient as a whole person allowed him to remain a trustworthy advocate in such a difficult situation. This unique relationship drew my attention to family medicine even further, and is what reinforces my desire on a daily basis. It is my desire to “be there through it all” for my patients, and I cannot imagine a more rewarding field.
My wish as a future family physician is to strive to provide complete medical care to underserved populations in our country, encourage my patients to take control of their own health, educate and expand health literacy, foster trusting partnerships between patient and provider, all while providing compassionate, dedicated, and personal care. I am optimistic, but not naïve. I know there will be days ripe with frustration, and days that will make me want to quit. There will be days when it feels as though no progress can be made and no patient can be saved. And there will be days I question a field in which I may spend more time with paperwork than I do patients, while earning the least among my colleagues. But even on these days, I will know that I am helping to fill the void in primary medical care. By doing so, I hope to give back to the greater community in which I was born and raised. The next time someone asks, “where have all the primary care doctors gone?” I will have my answer ready. I am here, and will be here – through it all.
What do you think? Did you like the essay? Why or why not? Did you choose primary care? Why or why not? Comment below!